- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.00 / $6,064.00 / $11,561.00
| Facility | | $2,264.00 | $6,064.00 | $11,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,437.00 / $19,117.00
| Facility | | $2,084.00 | $4,437.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.64 / $1,167.17 / $1,823.70
| Facility | | $972.64 | $1,167.17 | $1,823.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $10,075.00
| Facility | | $3,206.00 | $6,578.00 | $10,075.00 |